Features of the course of liver fatty degeneration in cholecystectomy and in non-operated patients of different age groupss

Abstract

INTRODUCTION: The combination of cholelithiasis and liver fatty degeneration (LFD) is becoming increasingly common. The postcholecystectomy complications significantly reduce the quality of life of patients who have undergone surgery. Complications of LFD stimulate a search for new prognostic markers and algorithms for timely initiation of effective treatment.

AIM: To identify prognostic criteria for complications of the course of LFD in the long-term period after cholecystectomy (CE) in patients of different age, and scientifically substantiate their significance for the earliest verification facilitating timely and effective treatment.

MATERIALS AND METHODS: To identify prognostic criteria for complication of the LFD course in the long-term period after laparoscopic CE, 301 patients (153 men and 149 women) were examined. Anthropometric data, hemodynamic parameters were assessed, autonomic regulation index was calculated. Ultrasound assessment of choledoch and liver elastography, magnetic resonance imaging of the liver and magnetic resonance cholangiopancreatography were performed. Laboratory parameters were analyzed. Using chromatography-mass-spectrometry, microbial markers of the parietal microbiome of the intestine were determined.

RESULTS: Complication of the course of LFD was associated with predomination of sympathetic regulation of the autonomic status in individuals under 60. At an older age, these influences were less pronounced. One year after CE, patients displayed an increase in body weight, more pronounced in the group < 60 years. This was associated with an increase in the choledoch diameter after CE, mostly in patients aged 45–59, being a sign of Oddi’s sphincter dyskinesia. A relationship was found between complication of the course of LFD and disorders of the structure of the intestinal microbial association caused by a decrease in the obligate microflora and increase in the opportunistic microflora, mostly due to the aerobic microflora; these changes were most evident in patients ≥ 60 years.

CONCLUSIONS: The complication of the course of LFD in the late period after CE is significantly affected by age, autonomic regulation, body weight and the structure of the resident intestinal microbial association. In the older group, autonomic regulation has a smaller effect, and an increase in body weight and a change in the structure of the intestinal parietal microbiome are greater than in younger individuals.

Keywords

fatty liver disease / cholelithiasis / cholecystectomy / postcholecystectomy syndrome / autonomic regulation / obesity

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